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Pain breakthrough dosing — DGM MCQ

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EasyEnd-of-life carePain breakthrough dosingDGM

An 86-year-old woman with metastatic breast cancer has background morphine but severe breakthrough pain on movement. She is alert and not nauseated. Renal function is stable. Current medicines include modified-release morphine and senna. What is the most appropriate management?

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Correct answer: D — Prescribe appropriate immediate-release opioid for breakthrough pain

Breakthrough cancer pain on background opioid requires an appropriate immediate-release opioid dose with review. Paracetamol alone is inadequate, waiting prolongs suffering, stopping laxatives worsens opioid constipation, and dependence is not the priority in palliative pain. Breakthrough analgesia should be available before predictable painful care or movement.

Reference: NICE palliative care guidance; BNF